Are painkillers really harmless?

NSAIDs is an acronym for nonsteroidal anti-inflammatory drugs. You are probably familiar with these drugs and may be one of the approximately 23 million in the U.S. who take them regularly. This group includes over-the-counter painkillers such as ibuprofen (Advil or Motrin), naproxen (Aleve) and aspirin. It also includes prescription medications including Celebrex.

A large portion of those who take these drugs regularly is made up of boomers, and especially adults 65 and older who take them to ease symptoms associated with osteoarthritis and to treat muscle aches and pains. These anti-inflammatory drugs also are taken sporadically for headaches, toothaches, colds, flu, menstrual cramps or to reduce fever. Because most of them are over-the-counter and readily available, plus the fact that they have been around for a long time, they are assumed to be perfectly safe. Are they? Let’s take a look.

As with most medically related issues, when you look closely, things are more complicated than they appear on the surface, and so it is with these drugs. In general, it has been known for a long time that they can cause harm to the cardiovascular system, the kidneys and the gastrointestinal tract. But the prevailing view has been that harm is likely to occur only in those who grossly overuse them, taking high doses too often, or those who used prescription medications like Vioxx or Bextra that were removed from the market due to increased risk of heart attack. Risk also may be elevated in those who consume more than a modest amount of alcohol while taking these drugs, or have certain pre-existing conditions aggravated by them.

Recently, the “harmless” stance has been challenged, and a public health coalition called the Alliance for the Rational Use of NSAIDs has been formed to promote awareness of the potential health risks involved.

What do we know?

Heart health experts tell us that these anti-inflammatory drugs carry some degree of cardiovascular risk, meaning an increased risk of heart attack, stroke and high blood pressure. The risk has been shown to be particularly elevated in those already at “higher” risk for heart disease. A study in the medical journal Circulation reported that in patients who had experienced a first heart attack, the risk of a second was 41 percent higher over the next five years among those who took these drugs.

In patients considered at “moderate” risk of heart disease, there still may be concern. A review of hundreds of medical studies indicated that high doses of ibuprofen increased the risk.

There is controversy surrounding the relative risk of some of these drugs. Some previous research had suggested that naproxen was safer than ibuprofen and Celebrex when it comes to heart disease risk. But the advisory committee for the Food and Drug Administration (FDA) just released a report that naproxen may not be less risky regarding heart disease when compared with other similar drugs.

What about aspirin? A low-dose aspirin is often prescribed to prevent blood clots that can cause a heart attack or stroke. But in higher chronic doses, there is some evidence that aspirin may cause hearing loss and tinnitus (ringing in the ears).

What to do?

The current trend toward casting a wary eye at these drugs should not be interpreted as telling everyone to avoid them. Rather, it seems the message is one of caution. These drugs are not harmless, especially in high chronic doses, and for those at risk of heart disease. A good rule of thumb is, if you feel you must take them for whatever reasons, select the lowest effective dose and take it for the least amount of time you can. And what about folks in pain from various sources who would find life intolerable without these drugs? It’s an individual decision, of course, and sometimes the benefits outshine the risks.

As always, consult your doctor to help you make the best decision.

Anita Miles Curpier is a health promotion consultant. She’s also a registered dietitian and has considerable experience in hospital and clinically based nutrition therapy. To contact her, email boomingcj@gmail.com.

For your health• Keep a list of all prescription and over-the-counter medicines you are taking including nutritional supplements. Bring this list with you when you visit your doctor.• Consult with your doctor before taking pain relievers to see which one is best for you.